Alaska Release of Medical Information, SHC-1012

State:
Alaska
Control #:
AK-SHC-1012
Format:
PDF
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Description

Release of Medical Information, SHC-1012

The Alaska Release of Medical Information, SHC-1012, is a form that patients can use to authorize a health care provider or other organization to release their medical records, such as test results, diagnoses, treatments, and other medical information. This form is used to protect patient privacy and ensure that medical records are not released to unauthorized individuals. There are two types of Alaska Release of Medical Information, SHC-1012: the standard form and the HIPAA-compliant form. The standard form is used for non-HIPAA compliant organizations and allows the patient to specify what information can be released and to whom it can be released. The HIPAA-compliant form is used for organizations that are subject to HIPAA rules and regulations and requires additional information such as the patient's Social Security number. Both forms must be completed and signed by the patient in order for the release of medical information to be valid.

How to fill out Alaska Release Of Medical Information, SHC-1012?

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Alaska Release of Medical Information, SHC-1012